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New Hampshire rates for HCPCS 21089

Unlisted Maxillofacial Prosthetic Procedure

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.09 / $1,359.00 / $3,300.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,718.51 / $4,821.79 / $5,881.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,040.00 / $2,117.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00